Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults
Publication Date: September 2, 2016
Guideline Status
This guideline has been retired by the Endocrine Society
Recommendations
Insulin pump therapy without sensor augmentation
We recommend continuous subcutaneous insulin infusion (CSII) over analog-based basal-bolus multiple daily injections (MDI) in patients with type 1 diabetes mellitus (T1DM) who have not achieved their A1C goal, as long as the patient and caregivers are willing and able to use the device. (1-M)
699
We recommend CSII over analog-based basal-bolus MDI in patients with T1DM who have achieved their A1C goal but continue to experience severe hypoglycemia or high glucose variability, as long as the patient and caregivers are willing and able to use the device. (1-L)
699
We suggest CSII in patients with T1DM who require increased insulin delivery flexibility or improved satisfaction and are capable of using the device. (2-L)
699
Insulin pump therapy in type 2 diabetes mellitus
We suggest CSII with good adherence to monitoring and dosing in patients with type 2 diabetes mellitus (T2DM) who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications. (2-L)
699
Insulin pump use in the hospital
We suggest that clinicians continue CSII in patients admitted to the hospital with either type of diabetes if the institution has clear protocols for evaluating patients as suitable candidates and appropriate monitoring and safety procedures. (2-L)
699
Selection of candidates for insulin pump therapy
We recommend that before prescribing CSII, clinicians perform a structured assessment of a patient’s mental and psychological status, prior adherence with diabetes self-care measures, willingness and interest in trying the device, and availability for the required follow-up visits. (1-L)
699
Use of bolus calculators in insulin pump therapy
We suggest encouraging patients to use appropriately adjusted embedded bolus calculators in CSII and have appropriate education regarding their use and limitations. (2-L)
699
Real-time continuous glucose monitors in adult outpatients
We recommend RT-CGM devices for adult patients with well-controlled T1DM who are willing and able to use these devices on a nearly daily basis. (1-H)
699
We recommend real-time continuous glucose monitoring (RT-CGM) devices for adult patients with T1DM who have A1C levels above target and who are willing and able to use these devices on a nearly daily basis. (1-H)
699
Use of continuous glucose monitoring in adults with type 2 diabetes mellitus
We suggest short-term, intermittent RT-CGM use in adult patients with T2DM (not on prandial insulin) who have A1C levels ≥7% and are willing and able to use the device. (2-L)
699
Education and training on the use of continuous subcutaneous insulin infusion and continuous glucose monitoring
We suggest that adults with T1DM and T2DM who use CSII and continuous glucose monitoring (CGM) receive education, training, and ongoing support to help achieve and maintain individualized glycemic goals. (UGPS)
699
Title
Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults
Endorsing Organizations
American Association for Clinical Chemistry
Association of Diabetes Care & Education Specialists
Publication Month/Year
September 2, 2016
External Publication Status
Published
Country of Publication
US
Document Objectives
To formulate clinical practice guidelines for the use of continuous glucose monitoring and continuous subcutaneous insulin infusion in adults with diabetes.
Inclusion Criteria
Male, Female, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Long term care
Intended Users
Diabetes educator, dietician nutritionist, nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D003920 - Diabetes Mellitus, D003922 - Diabetes Mellitus, Type 1, D003924 - Diabetes Mellitus, Type 2, D061385 - Insulins, D007328 - Insulin, D015190 - Blood Glucose Self-Monitoring
Keywords
insulin pump, CGM, Continuous Glucose Monitoring
Source Citation
Anne L. Peters, Andrew J. Ahmann, Tadej Battelino, Alison Evert, Irl B. Hirsch, M. Hassan Murad, William E. Winter, Howard Wolpert, Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 101, Issue 11, 1 November 2016, Pages 3922–3937, https://doi.org/10.1210/jc.2016-2534